First Call Information Form

We are very sorry for your loss and stand ready to assist you in your time of need. If you have not already scheduled a meeting with us, please call us.

If you prefer, you are welcome to send us information using the form below. We understand that you may not have access to all of the details below (or would prefer to provide in person). You are welcome to fill out as much or as little as you prefer. We will cover the remainder when we meet with you.

First Call Information Form

Free Text

Personal Information of Deceased

Choose Location to Handle Arrangements

Full Name of Deceased

Date of Birth

Date of Death

Current Location of Deceased (Address)

Approximate Weight of Deceased

Has a Doctor/Medical Examiner Been Notified? If decedent passed at home, doctor/ME must be notified PRIOR to removal

Yes

Unknown

Has the Body Been Released for Removal?

Yes

Unknown

Do You Permit Us to Embalm?

Yes

Undecided

Has an Autopsy Been Performed?

Yes

Unknown

Free Text

Physician Information

Name of Doctor or Medical Examiner Signing Death Certificate

Phone Number

Free Text

Personal Information of Person Legally Responsible for Disposition

Full Name of Next of Kin and Relationship to Deceased

Primary Phone Number

Primary Email Address

Name of Person Reporting Death and Phone Number (If NOK, type "Same as Above")

Thank you for contacting us.
We will get back to you as soon as possible.

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K. N. Jones Memorial Care, LLC

First Call Information Form

First Call Information Form

First Call Information Form

k.n. jones memorial care, llc

H.D. Weaver Memorial Chapel